Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Giuffrè, Mario; Bonura, Celestino; Geraci, Daniela Maria; Saporito, Laura; Catalano, R.; Noto, S.; Nociforo, Federica; Corsello, Giovanni; Mammina, Caterina

doi:10.1016/j.jhin.2013.08.004

Cited by 51 publications

(42 citation statements)

References 9 publications

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“…The sudden requirement for a prioritized cohorting of the patients colonized with KPC-Kp placed a major burden on the nursing staff and made it necessary to convert the separate intermediate care room into a KPC-Kp cohort room, while cohorting of patients positive for MRSA infection was forcedly restricted. 13 A seasonal variation was evident for MRSA colonization with incidence density peaking in the summer and autumn quarters (June-November). MRSA acquisition analyses included only the 832 participants whose first nasal swab was negative (Table 3).…”

Section: Incidence and Risk Factors For Mrsa Acquisitionmentioning

confidence: 96%

“…6 The declining trend came again to a halt in the 14th quarter concurrently with the emergence in the NICU of a strain of Klebsiella pneumoniae carbapenemaseproducing K pneumoniae (KPC-Kp). 13 Indeed, between September 18, 2012, and November 14, 2012, KPC-Kp was recovered from 10 neonates. The sudden requirement for a prioritized cohorting of the patients colonized with KPC-Kp placed a major burden on the nursing staff and made it necessary to convert the separate intermediate care room into a KPC-Kp cohort room, while cohorting of patients positive for MRSA infection was forcedly restricted.…”

Section: Incidence and Risk Factors For Mrsa Acquisitionmentioning

confidence: 98%

See 1 more Smart Citation

Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

Giuffrè¹,

Amodio²,

Bonura³

et al. 2015

American Journal of Infection Control

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Section: Incidence and Risk Factors For Mrsa Acquisitionmentioning

confidence: 96%

Section: Incidence and Risk Factors For Mrsa Acquisitionmentioning

confidence: 98%

Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

Giuffrè¹,

Amodio²,

Bonura³

et al. 2015

American Journal of Infection Control

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“…1,2 The recent outbreaks of carbapenemase-producing K. Pneumonia are of great importance. [3][4][5] Chlorhexidine was first introduced commercially in the United Kingdom as a disinfectant and topical antiseptic in 1954. 6,7 It is effective against Gram-negative, Gram-positive bacteria and fungi and kills by disruption of the cell membrane.…”

mentioning

confidence: 99%

A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery

Roode¹,

Bütow²

2018

Clin Med Res

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Objectives:Chlorhexidine is seen as the golden standard of disinfectants. It is widely used to clean surgical sites; however, many studies indicate resistance of pathogens to chlorhexidine. One study indicated that pathogenic microorganisms were isolated from the soft palate cleft region in 57% of patients with facial clefts. The objectives of our study were to determine (1) if chlorhexidine application is effective in removing pathogens from the surgical site in these patients, and (2) if any pathogens are isolated, determine if they are resistant to other antimicrobials. Design:A descriptive observational study. Settings:A private practice that specializes in facial cleft surgery, with a country-wide patient base. All procedures were executed by one oral and maxillofacial surgeon.Participants: All patients (N=50) who presented for primary repair of the soft palate cleft were included in the study. Inclusion criteria: written consent from parent(s), and patient cleared as systemically healthy by a pediatric physician. Exclusion criteria: patient(s) with systemic infections (eg, flu) and/or any local infections (eg, tonsillitis). There were 25 males and 25 females with an average age of 7 months and 16 days included in the study.Methods: Swabs were taken from the surgical site of all 50 patients with cleft soft palate and were sent for culture, identification and antimicrobial sensitivity. The swabs were taken before disinfecting the site as well as after 2 minutes of disinfecting the surgical site with chlorhexidine. Results were compared against each other.Results: Positive cultures with 28 different pathogenic microorganisms that were identified in 47 patients before cleaning the surgical site with the chlorhexidine. The most dominant pathogens were K. pneumonia (n=22), H. influenza (n=18) and S. aureus (n=10). Of the pathogens found, 13 (46%) were still present on the swabs taken after disinfecting with chlorhexidine. K. pneumonia (n= 13), H. influenza (n=11) and S. aureus (n=9) were still the most prevalent pathogens. Conclusions:This study demonstrated that 61 of the total of 113 pathogens isolated (54%), survived after 2 minutes of disinfecting the surgical and surrounding area with chlorhexidine, thus intensifying the chances of post-operative infection.

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“…Carbapenemase-producing Enterobacteriaceae (CPE) are prevalent worldwide in all areas of healthcare, with isolates and outbreaks reported in acute care facilities [1][2][3][4] including neonatology and pediatrics, 5,6 respite/convalescence facilities 7 and long-term care facilities. 8 Early detection and infection control strategies are key factors for successfully restricting onward transmission of CPE.…”

Section: Introductionmentioning

confidence: 99%

An optimized work-flow to reduce time-to-detection of carbapenemase-producing Enterobacteriaceae (CPE) using direct testing from rectal swabs

et al. 2016

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Rapid detection of patients with carbapenemase-producing Enterobacteriaceae (CPE) is essential for the prevention of nosocomial cross-transmission, allocation of isolation facilities and to protect patient safety. Here, we aimed to design a new laboratory work-flow, utilizing existing laboratory resources, in order to reduce time-to-diagnosis of CPE. A review of the current CPE testing processes and of the literature was performed to identify a real-time commercial polymerase chain reaction (PCR) assay that could facilitate batch testing of CPE clinical specimens, with adequate CPE gene coverage. Stool specimens (210) were collected; CPE-positive inpatients (n D 10) and anonymized community stool specimens (n D 200). Rectal swabs (eSwab TM ) were inoculated from collected stool specimens and a manual DNA extraction method (QIAamp Ò DNA Stool Mini Kit) was employed. Extracted DNA was then processed on the Check-Direct CPE Ò assay. The three step process of making the eSwab TM , extracting DNA manually and running the Check-Direct CPE Ò assay, took <5 min, 1 h 30 min and 1 h 50 min, respectively. It was time efficient with a result available in under 4 h, comparing favourably with the existing method of CPE screening; average time-to-diagnosis of 48/72 h. Utilizing this CPE work-flow would allow a 'same-day' result. Antimicrobial susceptibility testing results, as is current practice, would remain a 'next-day' result. In conclusion, the CheckDirect CPE Ò assay was easily integrated into a local laboratory work-flow and could facilitate a large volume of CPE screening specimens in a single batch, making it cost-effective and convenient for daily CPE testing.

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Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Cited by 51 publications

References 9 publications

Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery

An optimized work-flow to reduce time-to-detection of carbapenemase-producing Enterobacteriaceae (CPE) using direct testing from rectal swabs

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